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ozzynelson

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Hello all!

I am the owner of 2 diabetic cats: Ozzy and Nelson. Yay for me! Fortunately, Nelson is in remission. Ozzy, however, was diagnosed about 3 months ago, and he still isn't regulated. My vet and I decided to switch to Lantus Glargine after trying ProZinc and not seeing the results. (He was up to 3 units of Prozinc with sugars averaging 450). So, after having spent thousands of dollars between the 2 of them over the past year or so, I've decided after much research and blogging that it was time to be more proactive. I bought a glucometer and last Saturday, did my very first at-home glucose curve for Ozzy. I must have watched 100 how-to videos before i had the courage to test my kitty's blood. Since he absolutely loves having his ears cleaned/played with, it was relatively easy. So I hope that this is the right place to post the results. My vet charges $35 to analyze the curve via phone, and I just really want to try to do this myself and save some money. So, Ozzy got 1 unit of Glargine in the morning while he was devouring his Purina DM wet food (he LOVES this food!). I tested his blood once every 2 hrs until his next dose. I did not get a pre-shot reading of his sugar, though.

Here are the results:

478; 403; 352; 381; 391; 378

I've decided to increase his insulin from 1 unit 2x/day, to 2 units 2x/day.

Does this sound about right to you felinediabetes experts??

Thank you!!!
 
Wow, two FDs and one of them in remission, that's great.

I don't usually suggest increasing a dose based on one curve, but your cat was dx three months ago and numbers are high. I'd suggest that you also start testing for ketones because high numbers could lead to that, not always, but it's safest at these high numbers to check that. Ketone urine sticks are available at any pharmacy.

Going forward, please get AM and PM preshot numbers and when you post your numbers let us know how many hours from the shot, (+2 would 2 hours from the shot, +6 would be 6 hours from the shot). That helps you see how your cat is utilizing insulin.

So, at this point I would agree with a dose increase, but I'd also mention that you could read up on Lantus insulin on the insulin support group, there are stickies with info on how to store Lantus, how Lantus works, things like that.

Great job on hometesting. Food, you could do better. Even store bought Friskies or Fancy Feast would be better than Purina. Others can help you out with that.

http://felinediabetes.com/FDMB/viewforum.php?f=9
 
hi there and welcome.

i would also think an increase is probably warranted but, increases with lantus (aka: glargine) are usually not done in full unit increments due to how well so many kitties react to even the slightest change in dose. you don't want to increase to two and struggle for another few months only to discover that 1.25 units was the dose that was needed. make sense?

here's the links to the lantus info Jennifer recommended you read. read thru it and ask questions 'cause there's no way you can get it all overnight or without asking questions :smile:

first, here's a link to the lantus insulin support group
viewforum.php?f=9

and at the top of that group, beneath the announcements section, you'll find these links with info on lantus

viewtopic.php?f=9&t=18139
viewtopic.php?f=9&t=151
viewtopic.php?f=9&t=1581
viewtopic.php?f=9&t=150
 
Wow, how great are you!! Well done!

Here are the links with info on the insulin you are using:

Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
Lantus & Levemir: Info, Proper Handling & Storage has picture of syringe and insulin pens.


For the food, you really don't need to feed the expensive vet food, and you can likely find some better foods, and lower carbs (stick to below 10% carbs) - check on Binky's list for some foods to try.

Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

From the numbers you posted, you could use an increase in dose, but I think you could read the protocol which has increases done smaller - try 1.5u BID and see what kind of numbers you get when you test.
Testing is to be done before each shot, just to be sure it's safe to give the insulin. If you test and get a low number, you can post and ask what to do.

Here's a bit from the protocol:


"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
 
The dosing on the needles (u-100, I think?) are so much smaller than the ones I used with ProZinc. Even the needle itself is half the size - I worry that I'm injecting into the fur sometimes.

So i can see doing a 1.5 unit, but 1.25? Wouldn't that be near impossible to measure?

Thank you, everyone, for your advice. I must say that I thought I'd read EVERYTHING on the internet about FD, but this site is a universe of information! A bit overwhelmed at the moment, to be honest...
 
Hi and welcome to FDMB. And welcome to the vampire club.

I agree that going from 1 unit to 2 units may be too much of an increase. We recommend only raising the dose by 1/2 unit. Even though the increase seems small, often that may be all that is needed. Also, you will need to keep giving the same dose for at least a week before deciding you need to increase it. It takes that long for the body to adjust to the new dose. How long was he at the 1 unit dose? If it has not been at least on week, you should drop back to the 1 unit twice a day for at least one week before deciding if you need to adjust it.
 
ozzynelson said:
Ozzy was diagnosed about 3 months ago, and he still isn't regulated. My vet and I decided to switch to Lantus Glargine after trying ProZinc and not seeing the results. (He was up to 3 units of Prozinc with sugars averaging 450).
Click to expand...
Important question: How long has Ozzy been on Lantus?


Ozzy got 1 unit of Glargine in the morning ... I tested his blood once every 2 hrs until his next dose. I did not get a pre-shot reading of his sugar, though. Here are the results:
478; 403; 352; 381; 391; 378

I've decided to increase his insulin from 1 unit 2x/day, to 2 units 2x/day. Does this sound about right to you felinediabetes experts??
Click to expand...
If you want to follow the generally accepted protocol, then no, you wouldn't want to increase that much all at once. I believe the links and info has already been posted in this thread so I won't repeat it.

Again, though, how long has Ozzy been on Lantus? I ask because the amount of time on Lantus plays into the dosing decision. For example, he's only been on it for two days, then you would NOT want to increase just yet (Lantus takes time to build up in the system before you start seeing the true effects of a dose).
 
Thanks, everyone, for your support and advice.

I've read the Lantus protocol and I know that one shouldn't increase the dose until at least 2 to 3 weeks on a current dose. So, after 3 weeks on 1 unit of Lantus, and after getting opinions from my vet and a family friend (also a vet), I increased to 2 units. Interestingly, I asked my vet about the Lantus protocol and she said that that is an old and outdated study. I'm sure many of you will have lots of responses to that!

Anyways, poor Ozzy has been on 2 units of Lantus for 2 weeks, and he's just clearly not improving. The poor guy spends all day drinking and sleeping next to his water bowl, when he's not peeing in the litterbox, of course. He's a smart one. I'm just really frustrated in that it's been over 3 months, and now up to 2 units of Lantus, and he's still showing signs of high blood sugar. I'm going to do a new curve tomorrow. Will 3 units do the trick? Will I have to switch to yet a third kind of insulin??

Can I ask you Lantus users - do you all find that you prick your own fingers quite frequently? That needle is so small, I somehow end up pricking my own thumb everytime! Ozzy has lost a lot of weight, and there just isn't much skin to pinch when administering his insulin.
 
ozzynelson said:
I've read the Lantus protocol and I know that one shouldn't increase the dose until at least 2 to 3 weeks on a current dose. So, after 3 weeks on 1 unit of Lantus, and after getting opinions from my vet and a family friend (also a vet), I increased to 2 units. Interestingly, I asked my vet about the Lantus protocol and she said that that is an old and outdated study. I'm sure many of you will have lots of responses to that!
Click to expand...

The protocol was most recently published in the Journal of Feline Surgery in 2009. Most certainly not old and outdated. Also, it has been proven to work. Over 170 cats here, including my own, are in remission because of this protocol. It is also supported by research. I am curious to see what protocol your vet is using, and what research is backing it up because I haven't seen any supporting the dosing advice you're being given.

The problem with raising the dose so quickly is that you risk missing your cat's correct dose. Too much insulin will keep BG levels just has high as too little because Ozzy's body will dump glucose in his system in order to compensate for the overdose. Most cats never need more than 1u-2u once they have been switched to a low carb wet diet and any dental problems or infections have been treated.

I see you're home testing. If you set up a spreadsheet so that we can see your numbers, you will get much better dosing advice from the Lantus experts here. http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0
 
Here is a link to the 2009 article if you want to refer it to your vet: http://www.ncbi.nlm.nih.gov/pubmed/19592286

Your vet must be using the AAHA guidelines: http://www.jaaha.org/cgi/content/full/46/3/215

Those are general insulin dosing guidelines. We use a protocol specific to Lantus and supported by more recent research. If you look at the references used in the guidelines, you'll see that none of the articles that refer to glargine dosing in cats are more current than 2008. My current vet was using these, too, but I insisted we use the protocol here. Now she uses the protocol here since it worked so well with Bandit. When I last spoke to her a month ago, she said she was having much better results regulating more quickly.
 
Maybe this is a dumb question, but I'm confused about everyone talking about .25 incremental doses... The units on the U-100 syringes are sooo small - i can manage to measure 0.5 increments, but how in the world do you measure .25???
 
ozzynelson said:
Maybe this is a dumb question, but I'm confused about everyone talking about .25 incremental doses... The units on the U-100 syringes are sooo small - i can manage to measure 0.5 increments, but how in the world do you measure .25???
Click to expand...

Do your syringes have half unit marks? If so, you aim between the lines:

025unit-1.jpg


If they don't have half unit marks, then you can have your vet write you a script for them. I got mine at walmart.
 
come join us over in lantus land! It's a support group for lantus users. There are many very knowledgeable and loving people over there!

Hope to see you there soon
 
my vet gave the same advice as yours - i increased my cat by 1 unit every few days and then i got here discovering that we were on a dose of 8u twice a day - and LOTS of people have SUPER success with some cats only needing a 1 unit dose. you can increase by that tiny .25 units, really. maybe my cat would've needed that much insulin anyway, i don't know, some cats do and some cats need even more - but what i do know is that when i've adjusted his dose by as little as .25 units i see a change, and by going up by whole units we missed the opportunity to know if he would've responded on a smaller dose.

btw, you just do the best you can measuring that .25 and as long as you are consistent, that's what matters.

i've been on here for 2 months and almost every day a cat goes off of insulin by following this protocol. i would really encourage you to spend as much time as you have reading on this site and educating yourself so you can help your little buddy!

you can help him rehydrate by mixing water into his canned food - i do 50-50 water and food and both of my cats eat it just fine. that will help make it easier to give him shots.

you're in the right place now to get help! as you get more questions just ask - you'll have lots of questions as you go along.

welcome!
 
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